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2025 Long Island Heroes Breakfast Nomination Form

Describe your Hero

(Click 2025 here for Hero Award category descriptions)
1.Select the most applicable Hero Award category:(Required.)
2.Tell us about your Hero!

If this is a life-saving heroic event, please include:

  • Date within June 2024 - Present
  • Location of where the heroic action occurred
  • Circumstances surrounding how the Hero saved a life
  • Any other specific details that show the heroism of your nominee

If their heroic action is on-going (i.e. nonprofit) please include:

  • The organization's name, mission, website
  • Any statistics that show the impact made in the community
  • Any other specific details that show the heroism of your nominee
(Required.)
3.Include any links to online articles, photos, or media coverage related to the act of heriosim:
4.Hero Nominee Name(Required.)
5.Hero Nominee Prefix(Required.)
6.City Nominee Resides In(Required.)
7.Nominee Phone Number(Required.)
8.Nominee Email(Required.)
9.If other individuals supported this heroic action, please list the additional nominees' names (or indicate 'N/A')(Required.)
10.Additional Nominee(s) email address (or indicate 'N/A')(Required.)
11.Nominator Name (You!)(Required.)
12.Nominator Email(Required.)
13.Nominator Phone(Required.)
14.Nominator Relationship to Hero Award nominee(s)(Required.)
15.Nominator Occupation(Required.)
16.Witness Name

*A "Witness" is another individual that is very familiar with the nominee(s) heroic action(s) in the community, that can serve as a secondary point of contact for the Hero Nomination.
17.Witness Phone Number
18.Witness Email Address
19.How did you hear about the opportunity to nominate a Hero for the 2025 Long Island Heroes Breakfast?(Required.)